Plum Tree DBT Program

Dialectical Behavior Therapy (DBT) is a treatment that has been extensively researched, and shown to decrease self-injuring and/or suicidal behaviors. To provide DBT, therapists undergo intensive training with the founders of DBT. Our team meets weekly to review each teen’s progress in the program and strategize how to help even more. Our DBT team includes a pediatric neuropsychologist, adult psychologist, pediatric psychologist, two licensed clinical professional counselors, and one licensed counselor with an expressive/arts expertise.

Qualifications for admission into the Plum Tree DBT Program include:

Age 13-21

Resides with guardians

History of suicidal behaviors and/or self-harming behaviors

Emotional instability

Discretion of Plum Tree DBT team

Plus, at least 2 of the following:

Interpersonal problems

Family dilemmas

Confusion about self

Impulsive behaviors

All-or-nothing thinking

DBT for teens includes three essential parts: Individual Therapy, Family Skills Group, and Coaching Calls. If even one of these is missing, DBT treatment is no longer evidence-based or totally effective. Therefore, Plum Tree requires DBT Program participants to:

Commit to 20 weeks of treatment, with perfect attendance to all DBT sessions

Attend weekly, 60-minute, individual therapy with DBT Provider

Attend weekly, 60-minute, family skills group with DBT Provider

Teens make appropriate use of phone calls to DBT Provider for help in using new skills

Parents make appropriate use of phone calls to DBT Provider for help using/reinforcing new skills

Information about Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT) is a research-based mental health treatment developed by Dr. Marsha M. Linehan and her colleagues at the University of Washington. DBT combines principles and practices of Behaviorism, Cognitive-Behavioral Therapy (CBT), Eastern Mindfulness, Biosocial Theory, and Dialectics.

DBT was originally designed to treat borderline personality disorder (BPD) , which is characterized by symptoms of emotional dysregulation (extreme sensitivity), “black and white” thinking, chronic feelings of emptiness, thoughts or attempts of suicide or self-harm, inappropriate outbursts of anger, impulsivity, and a chronic instability in mood, behavior, sense of identity and relationships.

Over the past several years, the DBT model of therapy has been adapted to treat a broader range of mental health disorders, including: mood disorders (depression & bipolar), anxiety disorders (posttraumatic stress, generalized anxiety, panic disorder, and social anxiety disorder), eating disorders, substance abuse, self-harm in teens, and couples and relationship conflict.

DBT TREATMENT FOR ADOLESCENTS

Weekly Individual Therapy

In individual therapy sessions start by reviewing a weekly Diary Card, where the adolescent has monitored daily emotions, urges, treatment compliance, etc. This method of treatment clarifies the cause-and-effect role between thoughts, feelings, and behaviors. Alternatives to unsafe/ineffective behaviors are reviewed and practiced.

Weekly Family Skills Group

Family Skills Group is where each teen, plus at least one parent/guardian, attends a group session. This is where DBT skills are taught, reviewed, practiced, and reinforced. In adult DBT, families are not required to attend groups. But with adolescents, it is critical that a guardian learn, know, practice, and reinforce the adolescent’s new skills. There is much to learn on the family’s part. It is difficult for a teenager in a family to change behaviors, if everyone else stays the same. There are 5 modules (listed below) that are taught–one per month–over the course of the program.

1.) Mindfulness

Mindfulness helps people accept and tolerate powerful emotions. The concept of mindfulness and the meditative exercises used to teach it are derived from traditional Buddhist practice, though the version taught in DBT does not involve any religious or metaphysical concepts. Within DBT it is being able to pay attention—non-judgmentally—to the present moment. Mindfulness is living in the moment, experiencing one’s emotions and senses fully, yet with perspective.

2.) Emotion Regulation

Emotion Regulation is experiencing and expressing emotions without resorting to inappropriate, ineffective behavior. One way to increase emotion regulation is to reduce one’s vulnerability to intense emotions. Young people who have difficulty regulating emotions express themselves volatilely, such as screaming, lashing out verbally or physically, and acting aggressively toward themselves and others. These behaviors make it difficult for others to enjoy being around them, and then social problems get even worse. Emotionally dysregulated youngsters are more at risk of being excluded from social groups.

3.) Distress Tolerance

Life happens, including tough situations. Learning how to tolerate distressing emotions and events is important. Reacting with destructive emotions and behaviors only makes things worse down the road. Distress tolerance is managing unpleasant feelings and situations by using effective skills. It is often not possible to change circumstances of distressing events, but it is possible to bear pain skillfully.

4.) Interpersonal Effectiveness

Healthy relationships are equitable and balanced. Appropriate boundaries are important, including how to balance one’s priorities and demands with the other persons. Having effective relationships means having self-mastery, self-respect, and self-regard. It means knowing when and how to ask for help. It means knowing when to say “yes” to someone and when to say “no.” It is about getting one’s needs met, but not at the expense of another person’s needs.

5.) Walking the Middle Path

Walking the Middle Path is about avoiding extremes. It is seeing the truth in both sides of the story. Two things that seem like opposites can both be true. For example, these polar statements are viewed as both true: (A) The teenager is doing the best he/she can, and B) The teenager can do better. Parents can be firm AND gentle. Teenagers are independent AND dependent. Moving away from either/or thinking to both/and thinking improve the foundation from which parents and teens communicate. Walking the Middle Path is a module that is used only in DBT with adolescents.

Coaching Calls

The purpose of these calls is to coach participants—during stressful moments—to use DBT skills instead of resorting to ineffective behaviors. The calls are short—no more than 10-15 minutes. Teens are encouraged to call the individual therapist. Parents are encouraged to call the skills group leader. Parents use the calls to plan in the moment about how to use and reinforce DBT skills when a conflict occurs.